BeneFIT SIP: 14-012 A Pilot Program of Mailed FIT Tests to Increase Colorectal Cancer Screening Rates in Medicaid / Medicare health plans

What is BeneFIT? A 4-year SIP grant funded by the Centers for Disease Control in September 2015 to the Health Promotion Research Center at the University of Washington BeneFIT co-PIs: Laura-Mae Baldwin (University of Washington) Gloria Coronado (Kaiser Permanente Center for Health Research) Beverly Green (Kaiser Permanente WA) BeneFIT CDC collaborator: Jean Shapiro

BeneFIT Collaborative program with two Medicaid/Medicare health plans to implement and evaluate mailed fecal test (FIT) outreach Overall goal is to improve colorectal cancer screening rates among health plan enrollees

BeneFIT addresses low screening rates in Medicaid populations Colorectal cancer screening rates are low among Medicaid enrollees: Nationally, 36% of Medicaid-insured adults are up to-date on screening compared with 60% of commercially- or Medicare-insured adults. Medicaid enrollees are over 50% more likely than commercially insured adults to present with advanced-stage colorectal cancer. Little is known about the effectiveness of Medicaid direct-to- member mailed outreach programs.

To evaluate BeneFIT using mixed-methods, assessing BeneFIT Specific Aims To support health plans in implementing a mailed FIT outreach program for Medicaid and/or Medicare enrollees in Oregon and Washington To evaluate BeneFIT using mixed-methods, assessing Reach Implementation Effectiveness Maintenance This presentation will present results from the first year effectiveness study.

bENEfit Study Methodology Hybrid implementation-effectiveness study of two mailed FIT program models developed by health insurance plans. Primary effectiveness outcome: FIT completion rate within 6 months of initial mailing.

participating Health Plans Health Plan Oregon insures about 220,000 Medicaid and dual Medicaid- Medicare enrollees in Oregon. Health Plan Washington insures about 650,000 Medicaid and dual Medicaid-Medicare enrollees in Washington state.

Benefit process The health plans developed two very different models Quality teams designed their own programs to fit their contexts Research team provided expertise to the quality teams at the health plans

Health plan mailed fit program models Worked with clinics to confirm the list of eligible enrollees, co-brand mailing materials, and choose FIT test type that was specific to the clinic. Worked with an outside vendor for mailings. Collaborative Model Clinics or providers could opt out if desired. Worked with an outside vendor for most mailed FIT activities. Centralized Model

Collaborative model Eligible Enrollees Medicaid Health Plan Clinic

Collaborative model Eligible Enrollees Medicaid Health Plan Lab Clinic

Centralized model Lab Eligible Enrollees Medicaid Health Plan

Centralized model Lab Eligible Enrollees Medicaid Health Plan Clinic

BeneFIT Colorectal Cancer Screening Results by Health Plan

Predictors of FIT SCREENING for Enrollees in Oregon and Washington Patient characteristic OR WA Effect Gender -- NS Preferred language Race / ethnicity X Asian / Pacific Islanders/ Native Hawaiians FIT completion than whites Health insurance Dual-eligible enrollees FIT completion than Medicaid enrollees Residence location Rural residence FIT completion than urban residence Primary care visits in past year Enrollees with 1-3 or 4+ visits FIT completion than enrollees with 0 visits Jean, the next set of slides are long, and you will likely want to decide how to present. You could simply list significant predictors of FIT screening and all CRC screening for BeneFIT-eligible enrollees in OR and WA We’ve highlighted significant predictors in blue.

Effectiveness analysis Conclusions Health plans implemented two different mailed FIT program models tailored to their resources and culture – a centralized model and a model collaborating with health care systems. Both program models were effective and reached many individuals who were overdue for CRC screening. Next steps: evaluate rates of follow-up colonoscopy for positive FITs, as well as adaptations made and outcomes of the year 2 mailed FIT program

Benefit dissemination Three pronged approach Traditional academic publications 13 paper published, in process, or planned Presentations at national conferences 10 presentations given or planned Transforming our research findings into on-the-ground action More information: Attend communications panel at 2:00pm

BeneFIT Research Team Contact Information Laura-Mae Baldwin, UW co-PI Gloria Coronado, KPCHR co-PI Beverly Green, KPWA co-PI Richard Meenan, KPHCR, co-I Bill Vollmer, KPCHR, co-I Jennifer Schneider, KPCHR, co-I Amanda Petrik, KPCHR, Project Manager Malaika Schwartz, Project Manager CDC Project Officer: Jean Shapiro